07110049 CITY OF �UPERTINO ' ` .
BUILDING DIVISION PERMIT ������������"�����" `
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BUILDING ADDRESS: PERMfT NO.
10807 LINDA VISTA DR AAA FUR]JACE & AIR 07110049 .
,VER'S NAME: � �� DA �
YAZIE 1712 S`['ONE AVE � 11/09/2007
PHONE: SANTI'ARY NO. COMROL NO.
(408)293-4717
ARCHITECT/ENCiNEER: BUIC.DING PERMIT INFO
BLDG ELECf PLUMB MECH
0 � � 0
a p p LICENSED CON7'RACfOR'S DECLARAI'ION JOb DeSCflpt10f1
'r � C 1 hcrcby aflirm that I am licensed umlcr provisions of Chapicr 9(commcncing
z� wiih Section 7000) otDivision 3 of thc Business and Profcssiuns Codc, and my licensc is RE PLAC E FURNAC E 12 0 � � � � & A/ C 5 TON
�� y in full force and e[t �' j
; v� z u��nac c,uai ,� 5 L. 1 �[.ic. �e
+ �, o Dam - r - • Contractor �
ARCH1TECt'S DEC
��� I undcrstand my plans shall be used u public records y"��
�yU
; �. y Licensed Prufcssional
n y � OWNER-BUILDER DECLARATION
� <� I hcrchy alTirm ihat I am cxcmpt fmm �hc Contractor's Liccnsc Law for thc
L o O following rcason. (Sccdon 7031.5, Busincss md Profccsions Ca1c: Any city ar county
�,°, Pi which �cquiros a pcmiit to conswc4 a�tcr, impmvc, dcmalith, or repair any swaurc
� Z� prior w ils issuance, alw requims the applicant (or such permit to file a signed s�a�emenl
_< that he is liccnscd pursuant to ihc provisions of thc Conlractor's Liccnsc Law (Chaptcr 9 iq. Ft. Floor Area $ 4 5 0 0 Valuation
� F� (commencing wi�h Sccdon 7000) of Division 3 of �hc Busincu and Profcssiona Cadc) or
y �.. that he ia aempt thecefrom and ihe basis Cor the ailegcd eumpUon. Any violanon of
Section 7031.5 by a�ry applicant for a pem�it subjecu ihe applicant to a civil penalry of Number Oeeupancy Type
not more than five hundicd dollars (5500). 3 5 6 0 7 � 3 ���
❑ I. u owrrer o( the property, ar my employces with wages u ihe'v solc compensaUon,
willdothewodc,and�hestiucWmisnotimm�dcdoruRecedforsalc(Sa.7044.Business Re uired Ins ections
uc
and Pro[euions Code: 7he Conuactors License Law docs not apply a an owner of
propeny wha builds or improves thercon, and who does such worlc himaelf or through his
awn employces, provided that such improvemen�s are not intended or otfeced for sala If.
hawever, the building or improvement ia sold within one yesr o[ completion, d�e owner-
builder will have the burden oC proving that he did not build or improvc far purpoae of
sa�J.
0 I, as owner of �he property, am exclusively conuacting wiU� licenxd rnnuactors to
conswct �he project (Sec. 7044. Busineu and Profcssions Code:) 7he Conuacwr's Li-
cense Law docs not apply w an owner of propcny who builds or improves theceon, and ,
who contracts for such pmjects with a convactor(s) licensed pursuant to �he Convactar's
License Law.
'� I am exempt under Sec . B k P C for ihis icason
.vnw Date
WORKER'S COMPENSATION DECLARATION
I hercby affirm under penalty of perjury one of the follawing declaraGons:
❑ I hsve and will mainuin a Certificate of Consent to self-insure for Workkc�s Compen-
ution, u providcd fw by SecUon 3700 of the Labor Code, for ihe pefformance of rt�e
woric for which Uiis pertnit is issucd.
❑ I have and will maintain Workers Compensation Insurana, as required hy Scction
3700 of �he labor Code, Cw the pedormance of the worlc for w6ich this permit is issued.
My Worker's Compensuion csrricr and Poliry number aie:
Carrier. i '"'�' L.. n�� Policy No.: C�
KfIFI A E F EXEMPIION FROK1 RKERS• r
COMPENSATION INSURANCE '
(7'his scctian necd not be complcteJ if the permit is for anc hundred dollars (Sl W)
or Icss.) �
1 cenily thut in thc performancc of Ihc work for which �his permit is issucd, l shill not
e:nploy any person in any manner so u w becomc subjec� io ihe Workcrs Compcnsation
Laws of Cali(omia De�c
Applicant
N017CE TO APPLICAM: If, a(mr making �his CeniGca�c of Excmpuon, you should
bccome subjcct w �hc Worker'a Compcnsadon provisions of thc LsMr Code, you must
� O forthwilh camply with such provisions or this pccmit shall be dccmcd n.wokcd.
Z '"'' CONSTRUCTION LEND(NG AGENCY
[- i-�+ I hcfcby a�rtn ihat thcn is a conswction kndinE agcncy Cor ihc perCortnance uf .
a� �hc work for which this permi� is iuued (Scc. 3097, Civ. C.)
W� Q L.endcr's Namc �
� Z C.cnder's Address
V � 1 certifY ihrt 1 have rcad �his application and su�c that U�c above inCormatiun is
w� cortcct I agree to comply with all city and county ortlinances and sute Iaws retating to
0 U buildin6 conswction, and hc�cby authoria rcpresentativcs of Uiis ci�y w cnlcr upon thc
� W alwvc-mcndoned propcny for inspccuon purpaus.
a (We) a�ce �o save, indcmnify and kecp humless the City of Cuperuno against
H � liabiliuu, judgmcnts, costs and expenscs which may in any way acccuc againsl said City
V z in consequencc oC ihe gnnung ot ihis permi�
�"� APPWCANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date � l�' G�
SOU E REGULATIONS. f ,
� �.2-.. f/iG "�7 Re-roofs ��
�gnuurc of App �ant/Contract T— � �� T of R oof
HAZARDOUS MA7ERIALS D[SCLOSURE J��
�1l thc applicant or fuwrc building occupant uorc ar handle harardous matcrial
dcfined by Ihc Cupenino Municipal Codc, Chap�cr 9.12, and �he Health and Safety
.w�, Scction 25532(a)? All roofs �hall be inspected prior to any roofing material being installed.
❑ Ycs �o
� If a roof i;� installed without first obtaining an inspection, I agree to remove
Will thc applicant or�futurc building occupant usc cyuipmcnt or dcvices which
cmii harardous air conuminanu as dcfincd by �he Bay Arca Air Quslity Managcmcnt all new materials for inspec[ion.
��s����
❑ Yes u
I havc rcxl ihe ha»ard maicrials requircmcnu undcrChap�cr6.95 of �Mc Califor-
nia Hcalth & Safcty Codc, Scctiau 15505, 25533 and 25534. I undcrsmnd Uiu iC ihc huilding
dacs nol curtcntly havc a �cnant lhat it is my msponsibilily to naul'y the occupent nf �hc
reyuircments which must be me� 'or a issuance o[ a Cenifica�e of Occupancy. , S ignature of Applieant Date
<, a
� � All roof coverings to be Class "B" or better
O cr or autNorimd agcnl
� CITY OF C`UPERTINO
� —� � c � � �
i:�. � ' ��'"� �� . 1 C`i��.��t �� � .
CITY F
LUPEF�TINO PERMIT APPL:[CATION FORM
APN # 4 �� � � 2 � � Date:
J D O /- � �o
Building Address:
�
Owner's Na e: Phone #: �
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' Contractor: Phone: L�cense #:
.� � c �< < �/'- �Z 3 ._ � �
Contact: Phone: Cupertino Business License #:
� ! �Z� ��' ��� ' �Ss,� , o � °
Buildin Permit Info:
Bldg ❑ Elect I'lumb � Mech
Job Description:
" o �a� i �-- -_
Residential � Commercial ❑
For Residential Insta ations:
Attic � 1 St floor �2 floor �
�dhere to min set back requirement �
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) �
Structural Calculations required for new installation �
New installation Planning A proval Required ❑
Cost of Project: Type of Construc;tion: Occupancy oup:
��O
�,� n �
Strapped � On Platform ❑ Bonded L� Sq.Ft. Floor Area:
New Location � Replacement
Qty. if
Ap licable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
� BREMFURN F urnace MECHANICAL
BREMACOVER AlC Unit > 10,000 cfin MECHANICAL
BREMAIRHAN AIC Units <= 10, 000 cfin MECHANICAL
BREMRECEPT R.ecptl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE F1ec Permit Issuance ELECTRICAL
( MPERMITFEE l�iech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE E ldg Pernut Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS CTas Piping System Fee PLUMBING
BUSLIC Ftusiness License BUILDING
�
CITY OF CUPERTINO
7 ITEMS OF 7 PERMI'[' RECEIPT OPER.ATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: B11:: Lot:
APN ......... 35t>07032.00
DATE ISSUED.......: 11,'09/2007
RECEIPT #.........: BS()00003203
REFERENCE ID # ...: 07:.10049
SITE ADDRESS .....: 10£�07 LINDA VISTA DR
SUBDIVISION .......
CITY .............. CUF'ERTINO
IMPACT AREA .......
OWNER ............. YA�IE
ADDRESS ..........: 10F07 LINDA VISTA DR
CITY/STATE/ZIP ...: CUF'ERTINO CA, 95014-4748
RECEIVED FROM ....: JIN: RANDO
CONTR.ACTOR .......: RATDO, JIM LIC # 8050
COMPANY ..........: AAF FURNACE & AIR CONDITIONING
ADDRESS ..........: 1712 STONE AVE
CITY/STATE/ZIP ...: SAI� JOSE, CA 95125
TELEPHONE ........: (4C8)293-4717
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00
BREMAIRHAN NO.UNITS 1.00 10.26 0.00 10.26 0.00
BREMFURN NO UNIT 1.00 14.31 0.00 14.31 0.00
BSEISMICRE VALUATION 4,500.00 0.50 0.00 0.50 0.00
EPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00
MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
PPERMITFEE FLAT RATE 1.00 40..79 0.00 40.79 0.00
-------- ---------- ----------
TOTAL PERMIT : 182.30 0.00 182.30 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 182.30 VISA
---------------
TOTAL RECEIPT : 182.30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL